Employment

In the space below, provide a complete and accurate list of every public company for which the entity or an authorized person is:
(1) An officer or director; (2) A holder, directly or indirectly, of 5% or more equity interest; OR (3) A corporate "insider," "controlling person," member of a controlling group or representative of a corporate insider, controlling person or group.
Please DO NOT LEAVE BLANK; if none, write "NONE."

Company Name

CUSIP Number

Title

# Of Shares Owned

Affililiations and Acknowledgements

Please answer the following questions from the perspective of the entity-applicant.

Primary Bank or Credit Union*

Please list below any bank, credit union, or other financial institution where you hold a primary checking or savings account.

Firm Name

Location (City, State)

Other Accounts*

Please list below any other brokerage or investment firm(s) where you hold an account. If none, write "NONE."

Firm Name(s)

Location(s) (City, State)

Securities Industry Affiliation*

Are you employed by or associated with the securities industry or a financial services regulator? If yes, list associated firm(s) or organization(s) below.

Yes

No

Securities Industry Affiliation*

Firm Name(s)

Location(s) (City, State)

Government Entity*

Is this an account for a government entity? If yes, list title and country below.

Yes

No

Government Entity*

Entity

Country

Military or Government Affiliation*

Are you a senior military official in a non-United States country? If yes, list country below.

Yes

No

Military or Government Affliliation*

Title

Country

Institutional Account*

Is this account an institutional account, defined under FINRA R 4512(c) as either:
a. A bank, savings and loan association, insurance company or registered investment company;
b. An investment adviser registered either with the SEC under Section 203 of the Investment Advisers Act or with a state securities commission (or any agency or office performing like functions); or
c. Any other person (whether a natural person , corporation, partnership, trust or otherwise) with total assets of at least $50 million?

Yes

No

Information Release*

May we release your account information to issuers? (SEC regulations require that we obtain your permission to do so)

Yes

No

Large Trader ID No. (If applicable)

Suitability

Annual Income*

In what range is your annual income? (includes employment, alimony, social security, and all other income)

Assets Held Away

Please list the amount and the percentage of your assets held away in each of the asset categories listed below.

Stocks

Amount (in U.S. dollars)

Percentage

Bonds

Amount (in U.S. dollars)

Percentage

Options

Amount (in U.S. dollars)

Percentage

Commodities

Amount (in U.S. dollars)

Percentage

Fixed Insurance

Amount (in U.S. dollars)

Percentage

Variable Insurance

Amount (in U.S. dollars)

Percentage

Mutual Funds

Amount (in U.S. dollars)

Percentage

Tax Status*

For which tax bracket did you qualify on your most recent U.S. tax return?

15%

20%

25%

28%

33%

35% or higher

Did not file

Tax Status

Liquidity Needs*

Liquidity is the ability to quickly and easily convert to cash all or a portion of the investments in this account without experiencing significant loss in value from, for example, the lack of a ready market, or incurring significant costs or penalties. Please check only one box that best describes how important liquidity is for you.

Very Important

Important

Somewhat Important

Does not matter

Special liquidity need (please describe)

Liquidity Needs

Annual Expenses*

What are your annual expenses? (recurring expenses; could include mortgage payments, rent, long-term debts, utilities, alimony, and child support payments)

$50,000 and under

$50,001-$100,000

$100,001-$250,000

$250,001-$500,000

Over $500,000

Special Expenses*

What are your special expenses? (future, non-recurring; could include a home purchase, home remodeling, a car purchase, education, and medical expenses)

$50,000 and under

$50,001-$100,000

$100,001-$250,000

$250,001-$500,000

Over $500,000

Timeframe for Special Expenses

In how many years do you expect to finish paying for your special expenses?

Within 2 years

3-5 years

6-10 years

10-20 years

Over 20 years

Investment Objectives

Investment Objectives*

Please read the listed investment objectives and check all that apply.

Speculation: I am willing to accept maximum risk to my initial principal to aggressively seek maximum returns, and understand I could lose most, or all, of the money invested.

Growth: I am willing to accept high risk to my initial principal, including high volatility, to seek higher returns over time, and understand I could lose a substantial amount of the money invested.

Income: I am willing to accept some risk to my initial principal and tolerate some volatility to seek higher returns, and understand I could lose a portion of the money invested.

Safety of Principal: I want to preserve my initial principal, with minimal risk, even if it means this account does not generate significant income or returns and may not keep pace with inflation.

Other: Please describe below

Investment Objectives

Risk Tolerance and Investment Experience

Investing involves risk. Different investment products and strategies involve different degrees of risk. The higher the expected returns of a product or strategy, the greater the risk that you could lose most of your investment. Investments should be chosen based on your objectives, timeframe, and tolerance for market fluctuations. Based on this, select the degree of risk you are willing to take with the assets in this account.

Risk Tolerance*

Conservative

Moderately Conservative

Moderate

Moderately Agressive

Significant Risk

Time Horizon*

In how many years do you expect to achieve your objectives?

Under 1 year

1-2 years

3-5 years

6-10 years

11-20 years

Over 20 years

Investment Experience

Please fill in your amount (in years) of experience with each of the following.

Reach Us

Phone:

(303) 740-8448

Toll Free:

(800) 288-8448

Fax:

(303) 874-1090

About Us

Spencer Edwards, Inc is a Denver, Colorado based FINRA Member Retail Broker-Dealer/Investment Banker and NASDAQ Exchange Member acting as an investment banking firm specializing in small and mid cap equities.

Our Professionals

In business since 1990, Spencer Edwards brings together a diverse, qualified and proficient management team, seasoned brokers and professional equity traders with experience spanning four decades of market making.